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I began the preface to the first edition of this text by posing several questions: “Why write a book about a dying art, about a skill with little science, or about a service that is no longer in the main purview of the dental profession?
Is not edentulism on the decline because the youth today will keep their teeth for life? Have not oral implants transformed the edentulous mouth into a foundation for fixed prostheses?” I continue to hear these questions, even accompanied by the ring of ageism: “Isn’t tooth loss an old person’s affliction?” Everyone in dental academia knows that the curriculum has moved away from prosthodontics to embrace, it is said, knowledge that is much more relevant to the dentist in the new millennium.
1 The seminal question remains on the agenda of most dental faculties: “Why bother with the complete denture?” But, as I explained in the first edition, the art and science of complete dentures provides the foundation for so much of a dental clinician’s day: listening to patients; probing for diagnostic clues; distinguishing healthy from diseased tissues and functional from dysfunctional structures; assessing the arrangement of teeth for patients who are concerned about dentofacial disfigurements and for occlusal contacts that are physiologically unstable; making impressions; using dental articulators;
manipulating an array of biomaterials; and communicating their observations and recommendations to others. There has been remarkably little attention given in either dental education or the related sciences to the management of chronic disorders, yet we know that successful aging is influenced strongly by the long-term skills people develop to adapt and cope with chronic adversities.2,3 As clinicians, we are skilled in the techniques to remove, change, and replace structures in and around the mouth. We can deliver the most exquisite prostheses, far beyond the expectations or demands of most patients. Yet, we are much less skilled at maintaining a comfortable quality of life with minimal effort and expense to patients and ourselves.4 Almost everywhere, there has been an excellent trend away from complete tooth loss, and more people than ever before are retaining some natural teeth for life. However, the epidemiologic data available on the prevalence and incidence of tooth loss is sadly wanting.5 Steele et al6 reported from a 2009 survey of oral health in the United Kingdom that “[a]lthough the percentage of people who are edentate is small, it still accounts for approximately 2.7 million adults across England, Wales, and Northern Ireland.” The 2007 to 2009 Canadian Health Measures Survey found that 6.4% of adults aged 19 to 79 had no natural teeth, which amounts to about 1.5 million adults in Canada, excluding indigenous peoples, who need complete dentures.7 The equivalent number of edentulous adults in Australia is about 1.2 million.8 Therefore, no matter how or where we look, we cannot say with any confidence that patients in the near future will not need or want full dental prostheses.
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